Meeting the Health Needs of Refugee and Internationally Adopted Children

Awaiting the arrival of a child is filled with joy, but also fraught with anxiety.
Will the child be healthy? Will I be a good parent? How will the household adjust?
All that is true, and more, when families adopt a child from overseas. That is what
makes SLU's Foreign Adoption Clinic and Educational Services (FACES) center so invaluable.

It's been 20 years since SLUCare pediatrician Dr. Jennifer Ladage adopted her first child from Nanjing, China. She knew immediately he had health issues:
rickets and a cleft palate were apparent. Ladage joined support groups for international
adoptee families, but she felt the need for a better way to educate new parents about
the physical and emotional problems specific to internationally adopted children.
So, in 1999, with help and funding from her alma mater, Saint Louis University, she
founded the clinic, now a nurturing resource for the families of children from faraway
lands. "I had done my residency at SLU, so it made sense to approach them, and they
recognized the need," Ladage says.

We became aware that refugee children were having trouble assimilating at school because
of unmet health needs.”

In 2012, the SLU clinic, located at SSM Health Cardinal Glennon Children's Hospital,
began working with refugee children and their families, too. "We became aware that
refugee children were having trouble assimilating at school because of unmet health
needs," Ladage explains. After an initial evaluation, the youngsters are transferred
to the care of the other SLUCare physicians.

Both of these childhood populations face challenges, Ladage explains. While orphans
from abroad often have problems with attachment, refugees are more prone to the effects
of trauma, like depression, anxiety and PTSD, she says. "It is very likely a child
coming from an orphanage has suffered from an impoverished start in life, single parent
situations where there may have been mental illness, drug use and other risky behaviors."
But along with a nurse, psychologist and occupational therapist, Ladage addresses
and treats all the initial medical, physical, emotional and psychosocial needs of
these children and their families. In addition, the clinic assesses a child's needs
prior to adoption (as best it can) by reviewing family history, medical documents
and photographs.

Dana Galbraith, a doctor and former medical missionary, first met Ladage at a training
session before adopting her first child from Ethiopia in 2011. "The emotional aspects
[of international adoption] are huge," Galbraith says. "You are bringing a child from
a hard place." She adds that when her boys arrived, they were malnourished and had
parasites from drinking dirty water. FACES, she says, tested for infection and provided
all immunizations.

Although thousands of children have been adopted from outside the United States annually
since 2002, Ladage reports a general decline in numbers as the process has changed.
"It's less about money these days, and more about the well-being of the child," she
says, adding that the Hague Adoption Convention, signed by the U.S. in 2008, may have
reduced many countries' ability to place children outside their borders. While adoption
numbers have declined, the number of refugee children treated by the clinic has increased;
two-thirds of patients are refugees from places like Cuba, Somalia, Congo, Myanmar,
Nepal, Syria and Iraq. Meanwhile, the adoptees come from China, Korea, the Philippines,
Ethiopia and countries in Eastern Europe. The children find their way to the clinic
by word of mouth, or adoption agency referrals and via the International Institute
of St. Louis, which helps resettle and integrate immigrant populations. Working together
with other caring service agencies, FACES eases the transition for young, new St.
Louisans.

Based at SSM Health Cardinal Glennon Children's Hospital, SLUCare's Foreign Adoption
Clinic and Educational Services (FACES) is a comprehensive program that addresses
the medical, physical, emotional and psychosocial needs of internationally adopted
and refugee children and their families. For more information on services or an appointment,
call 314-268-4150 or email facesintl@slu.edu.